Lymphocytic Hypophysitis Causing Hypopituitarism and Diabetes Insipidus, and Subsequent Association With Primary Autoimmune Hypothyroidism and Type 1 Diabetes Mellitus, in a Nonpregnant Female With Complete Recovery of Pituitary Function and Pregnancy

Abstract

We describe a case of lymphocytic hypophysitis (LYH) in a 25-year-old nulliparous woman who presented with marked lethargy, profound tiredness, weight gain, postural hypotension, and visual disturbance. Endocrine investigations revealed low thyroid stimulating hormone, low T4, and high prolactin levels. Her CT scan revealed a macroadenoma with suprasellar extension, encroaching on the optic chiasm. In view of visual disturbance and clinical hypopituitarism, transphenoidal resection of the tumor was performed and normal-looking pituitary tissue was preserved. Histology revealed LYH. During postoperative period, she developed diabetes insipidus followed by type 1 diabetes mellitus and autoimmune primary hypothyroidism. Over a period of 3 years, her pituitary function completely recovered. Subsequently she had 2 successful pregnancies. She has been followed for 10 years with no recurrence of LYH. The recovery of pituitary function in LYH and subsequent successful pregnancies as well as the association with diabetes insipidus and primary autoimmune thyroiditis are recognized. The association with type 1 diabetes mellitus, however, is unusual. This case highlights the importance of careful follow up because spontaneous remission of pituitary hormone deficiencies and the emergence of other autoimmune diseases can occur.